急性心肌梗死后射血分数保留、中间范围和降低的心衰中新发心房颤动的预后意义：来自 NOAFCAMI-SH 注册研究的数据。

Prognostic Significance of New-Onset Atrial Fibrillation in Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction Following Acute Myocardial Infarction: Data from the NOAFCAMI-SH Registry.

机构信息

Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.

出版信息

Clin Interv Aging. 2022 Apr 13;17:479-493. doi: 10.2147/CIA.S358349. eCollection 2022.

DOI:10.2147/CIA.S358349

PMID:35444413

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9014224/

Abstract

PURPOSE

The prognostic impact of new-onset atrial fibrillation (NOAF) among different heart failure (HF) subtypes including HF with preserved (HFpEF, ejection fraction [EF] ≥50%), mid-range (HFmrEF, EF 40%~49%), and reduced (HFrEF, EF <40%) EF following acute myocardial infarction (AMI) remains unclear. We aimed to investigate the incidence and prognostic implication of post-MI NOAF across HF subtypes.

PATIENTS AND METHODS

We included 1413 patients with post-MI HF (743 with HFpEF, 342 with HFmrEF and 328 with HFrEF) between February 2014 and March 2018. NOAF was considered as patients without a preexisting AF who developed AF during the AMI hospitalization. The primary endpoint was all-cause mortality.

RESULTS

Of 1413 patients (mean age 66.8 ± 12.6 years, 72.9% men) analyzed, 200 (14.2%) developed post-MI NOAF. Patients with HFrEF were more likely to experience NOAF compared to those with HFmrEF or HFrEF (18.9%, 13.7% and 12.2% in HFrEF, HFmrEF and HFpEF, respectively; p for trend = 0.006). During a median follow-up of 28.5 months, 192 patients died (70 with HFrEF, 35 with HFmrEF and 87 with HFpEF) and 195 patients experienced HF rehospitalization (79 with HFrEF, 37 with HFmrEF and 79 with HFpEF). After multivariable adjustment, NOAF was independently associated with all-cause mortality (hazard ratio [HR]: 1.79, 95% confidence interval [CI]: 1.03-3.12) only in the HFrEF group compared to sinus rhythm (SR), whereas an increased risk of HF rehospitalization was found in all HF subtypes, particularly in HFmrEF (HR: 5.08, 95% CI: 2.29-11.25) and HFpEF (HR: 2.83 95% CI: 1.64-4.90).

CONCLUSION

In patients with post-MI HF, NOAF carried a worse prognosis for all-cause death in the HFrEF group and for HF rehospitalization in all HF subtypes.

摘要

目的

急性心肌梗死（AMI）后不同心力衰竭（HF）亚型新发房颤（NOAF）的预后影响仍不清楚，这些亚型包括射血分数保留型 HF（HFpEF，射血分数 [EF]≥50%）、中间范围射血分数保留型 HF（HFmrEF，EF 40%~49%）和射血分数降低型 HF（HFrEF，EF<40%）。本研究旨在调查 AMI 后 HF 各亚型中发生 NOAF 的发生率和预后意义。

方法

我们纳入了 2014 年 2 月至 2018 年 3 月期间 1413 例 AMI 后 HF 患者（HFpEF 743 例、HFmrEF 342 例和 HFrEF 328 例）。NOAF 被定义为既往无房颤的患者在 AMI 住院期间发生房颤。主要终点为全因死亡率。

结果

在 1413 例患者（平均年龄 66.8±12.6 岁，72.9%为男性）中，200 例（14.2%）发生了 AMI 后 NOAF。与 HFmrEF 或 HFpEF 相比，HFrEF 患者更易发生 NOAF（HFrEF、HFmrEF 和 HFpEF 中分别为 18.9%、13.7%和 12.2%；趋势检验 p=0.006）。中位随访 28.5 个月期间，192 例患者死亡（HFrEF 70 例、HFmrEF 35 例和 HFpEF 87 例），195 例患者因 HF 再住院（HFrEF 79 例、HFmrEF 37 例和 HFpEF 79 例）。多变量调整后，与窦性节律（SR）相比，NOAF 仅在 HFrEF 组与全因死亡率相关（风险比 [HR]：1.79，95%置信区间 [CI]：1.03~~3.12），而 HF 再住院风险在所有 HF 亚型中均增加，特别是在 HFmrEF（HR：5.08，95%CI：2.29~~11.25）和 HFpEF（HR：2.83，95%CI：1.64~4.90）中。